Summary

Natural disasters and weather events can lead to a wide range of deleterious health effects, including mental health problems. Psychiatrists have important roles in disaster planning and preparedness, and in short and longer term responses.

Background

Natural disasters and extreme weather events, including those linked to climate change, can lead to a wide range of deleterious health effects. This includes mental health problems and mental disorders, health risk behaviours and effects on other social and behavioural domains, health perceptions and physical health. However, most people show resilience and recover well.

There are groups in society who are more vulnerable or have special needs in post-traumatic situations including children, people from culturally and linguistically diverse communities, rural and remote communities, the elderly and people with pre-existing psychiatric disorders and medical conditions (Ober et al., 2000; McDermott, 2005). Indigenous people with close emotional and ancestral ties to the land are also likely to be disproportionately affected by environmental change and extreme weather events (UNDESA, 2010). People who have pre-existing psychiatric morbidity when a disaster occurs are at greater risk and may need to be closely monitored.

Emergency and recovery workers dealing with the clean-up and repair of the disaster region must be well briefed, well prepared, well led and offered sufficient peer and social support. Provisions should be made to address such issues systematically through occupational mental health and safety programs. In providing support to emergency and recovery workers, individually tailored approaches are considered best practice. This must occur within the context of an understanding that the care and management of psychological trauma is not just a matter for the short term, and requires a long term view and follow up. Planning should be undertaken to ensure readiness for future traumatic events so that the response is informed and evidence-based. Planning for disaster preparedness should take a multi-sectoral approach and include the expertise of psychiatrists and other mental health professionals.

Psychiatrists who become involved in management of disasters must be knowledgeable about the systems for planning and response and the role that they will play. Psychiatrists, alongside other mental health professionals, government and non-governmental agencies, have important roles in disaster planning and preparedness, as well as in immediate, short and longer term responses to the incident.

Prior to the event

During times of stability, psychiatrists should work with other services in effective planning and preparation so that best practice systems and responses are ready to be rolled out following an event. They can participate in providing training and education to mental health, medical and other health professionals involved in providing services and clinical responses in order to increase the likelihood of evidence-based effective interventions being provided for those adversely affected.

Psychiatrists and other mental health professionals should also undertake research into strategies for resilience building, prevention and effective treatments for people who have been traumatised. With respect to the risks posed by climate change mental health institutions, practice and activities have a role in reducing carbon emissions and enhancing sustainability.

Following the event

Following natural disasters and climate change-related weather events, psychiatrists can work in collaboration with other mental health professionals, emergency responders and recovery agencies, as leaders in service delivery and clinical care. Psychiatrists have a key clinical leadership role in providing treatment for people who develop mental health disorders following exposure to a traumatic event, as well as those with pre-existing mental health problems whose condition may have deteriorated.

Consultation-liaison psychiatric services engaging with the injured population are essential at this stage. People with physical illness or injuries may present with an increased risk of mental health comorbidities, and consultation-liaison psychiatrists should be present to assess this. Consultation-liaison work should extend to general advice for community leaders, as well as to emergency services organisations.

Psychiatrists should also be present to provide expert mental health advice and support to other groups, such as general practitioners and counsellors, following a disaster. Research shows that common post-disaster mental health morbidities such as post-traumatic stress disorder tends to be under-recognised and that referrals to mental health specialists by generalist medical practitioners tends to be much lower than the rate of mental health complications in affected populations (Brewin et al., 2010).

Where distress persists and symptoms emerge in the weeks following the traumatic event, psychiatrists can be amongst the health professionals who provide simple psychological strategies that promote recovery and allow early detection of more serious problems. A small but significant number of people exposed to these traumatic events develop clinical disorders and severe distress. Psychiatrists and other mental health clinicians will then provide evidence-based psychological and pharmacological treatments. In these cases, psychiatrists would normally work with others dealing with physical health, welfare, and accommodation, work and school systems to ensure a coordinated approach.

Psychiatrists should be mindful of the way natural disasters and climate change-related weather events can impact on people who have not been directly involved.

Supporting rural and remote communities

The impacts of natural disasters can be further devastating for people in rural and remote settings. Geographical barriers can lead to significant delays in the arrival of rescue and response teams, prolonging trauma in these communities, delaying the availability of mental health support, and exacerbating emotional distress. This is especially the case when the accessibility of necessities such as shelter, clean water, medication, power and food are also affected.

Extended exposure to traumatic circumstances combined with delayed access to mental health services, information and resources can increase risk of mortality and morbidity immediately following the event, resulting in higher levels of social and emotional wellbeing problems, and a heightened risk of mental illness in the longer term.

Additionally, psychiatrists, other health workers, carers and whānau may themselves struggle with lack of access to information and resources prior to, in anticipation of and following natural disaster and climate change-related extreme weather. This can limit the capacity of this group to deliver support, impacting on the sustainability of these vital roles and leading to burnout.

Communities, including traditional Māori and Aboriginal and Torres Strait Islander institutions play a crucial role in providing support, reassurance and solutions to problems faced as a result of loss, destruction and disconnection from home and country. In New Zealand these include the Pa, Marae, Hapū and Iwi. In Australia, the RANZCP recommends consultation and liaison early on with local Aboriginal and Torres Strait Islander elders to identify relevant community groups and leaders. It is vital that professional services work closely with grassroots representatives to ensure culturally appropriate and meaningful psychosocial recovery.

United Nations Department of Economic and Social Affairs (2010) State of the World’s Indigenous People. Division for Social Policy and Development. Secretariat of the Permanent Forum on Indigenous Issues. ST/ESA/328.

Disclaimer: This information is intended to provide general guidance to practitioners, and should not be relied on as a substitute for proper assessment with respect to the merits of each case and the needs of the patient. The RANZCP endeavours to ensure that information is accurate and current at the time of preparation, but takes no responsibility for matters arising from changed circumstances, information or material that may have become subsequently available.